title: Differential effects of donor-specific alloantibody.
abstract: Alloantigen exposure typically provokes an adaptive immune response that can foster rejection of transplanted organs, and these responses present the most formidable biological barrier to kidney transplantation. Although most cellular alloimmune responses can be therapeutically controlled with T-cell-specific immunosuppressants, humoral alloimmune responses remain relatively untamed. Importantly, humoral immunity, typically manifesting as allospecific antibody production, is increasingly recognized for its variable appearance after kidney transplantation. Indeed, the appearance of alloantibody can herald the onset of rapid and destructive antibody-mediated rejection or have no demonstrable acute effects. The factors determining the end result of alloantibody formation remain poorly understood. This review will discuss the breadth of alloantibody responses seen in clinical kidney transplantation and provide an overview of potential factors explaining the phenotypic variability associated with humoral alloimmunity. We propose several avenues ripe for future investigation including the influence of innate immune components and the potential influence of heterologous immune responses in determining the ultimate clinical import of an alloantibody response.
authors.affiliation: Emory Transplant Center, Emory University, 5105-WMB, Atlanta, GA 30322, USA. nturgeo@emory.edu
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Turgeon
authors.forename: Allan D
authors.initials: AD
authors.lastname: Kirk
authors.forename: Neal N
authors.initials: NN
authors.lastname: Iwakoshi
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000917:Antibody Formation; D000918:Antibody Specificity; D023201:CD40 Ligand / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D007075:Immunoglobulin M / Q000276:immunology; D007155:Immunologic Factors / Q000627:therapeutic use; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology*; D016031:Liver Transplantation / Q000276:immunology; D016040:Lung Transplantation / Q000276:immunology; D000069283:Rituximab; D013601:T-Lymphocytes / Q000276:immunology*; D014019:Tissue Donors; D017211:Treatment Failure
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D006680:HLA Antigens; D007075:Immunoglobulin M; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D023201:CD40 Ligand; D000069283:Rituximab